Electronic Health Records (EHR) frequent news headlines with President Barack Obama’s roll out of the American Recovery and Reinvestment Act (ARRA). In this plan, the government earmarked more than $1 billion for the deployment of computerized health information. According to the American Medical Association, the U.S. Senate passed ARRA to encourage physicians and hospitals to adopt and use certifiable electronic health records, computerized records that are created and maintained electronically.
There is a long history of health information management (HIM) in the United States. The health information industry has been around officially since 1928 when the American College of Surgeons (ACOS) sought to increase and improve the standards of records that were created in the clinical setting– that is—during the diagnosis and treatment of healthcare patients. ACOS sought to achieve their goal for improving clinical records by establishing the American Association of Record Librarians, a professional association that is still in existence today under the name American Health Information Management Association (AHIMA).
The 1920s and Health Records
In the 1920s, individuals came to a realization that documenting the provision of healthcare was of great value to health care providers and to patients themselves. This unprecedented activity soon became wildly popular and used around the nation after health care providers realized that records established the details, complications, and outcomes of patient care were useful and even critical to the safety and quality of the patient experience. Physicians recognized that they were better able to treat patients with complete and accurate patient history. Medical records of this day were documented on paper which explains the naming of the first professional group as “record librarians” or keepers of books because all patient treatment was recorded on paper.
Medical Records in the Information Age
Paper medical records were kept and maintained in steadfast fashion from the 1920s forward; but as the development and deployment of the computers began in the 1960 and 1970s, pioneering American universities began exploring the marriage of computers and medical records. These universities often partnered with large healthcare facilities where the patient information was created and the materialized software was only useful at that single health care facility. This obviously restricted the product’s usefulness and viability out on the market.
Other hindrances of these efforts included computer performance limitations, exorbitant pricing, and the progression of the computer/medical record relationship. However, interest in computers continued to increase and the application in healthcare began to redirect to individual departments within healthcare such as patient registration and also to individual functions within the medical record industry. Interestingly—in the 1980s—healthcare computer development continued with a focus oriented on a single application or use in a health care setting.
The 1980s and Healthcare Software Development
In this era, healthcare software development successes were deployed in different hospital departments including the notable success of computerized admission registration and computerized master patient indexes. For the first time in healthcare history, patients began experiencing and benefiting from computerized check in. The master patient index (MPI) benefit was primarily enjoyed by personnel in the medical record department.
The Golden 90s
Armed with MPI and registration development, software developers continued to create and develop with a new focus on individual hospital departments. Ancillary department functions, such as laboratory and radiology proved to be quite adaptive to new software, and computer healthcare applications began to appear on the market. Patient test results that originated in the radiology and laboratory department now too were available via computers but again with restriction as the results were standalone and were not connected to one another, or to any other software such as that being used in patient registration. These applications were tagged as “source” systems, and they were not amenable to linkage across the healthcare facility. This is the circumstance that computerization in healthcare found itself in until the 1990s – computer applications were being used within healthcare walls but none of them could associate with the other, none could be viewed by neighboring departments, and most were using their own computer hardware that was restricted to the department of origin. This is akin to each state in the U.S. having its own set of roads that don’t cross over and connect with any other state- where would travel be without benefit of interstate highways?
Meanwhile, computerization outside of healthcare was flourishing with great successes in the communication and entertainment industries as well as others, and computerization within healthcare had come to a roadblock. Healthcare was without a true communicative, cross departmental electronic record and was struggling with the challenge. By the year 2000, a reemphasis for an electronic record emerged because of medical errors and increasing numbers of patient deaths and injuries caused by healthcare providers. As stated on the government’s Centers for Medicare and Medicaid website, electronic health records would allow “Providers to make better decisions and provide better care” and “Reduce incidence of medical error by improving the accuracy and clarity of medical records”.
Millennial Medical Records
Further emphasis was placed on the need for EHR advancement by President George W. Bush when he stated in his January 2004 State of the Union address “By computerizing health records, we can avoid dangerous medical mistakes, reduce costs and improve care”, (http://stateoftheunionaddress.org/2004-george-w-bush). The interest in successful electronic record deployment has progressed since that time and today rests with the ARRA. An advancement of the ARRA has resulted in the recent unveiling of Regional Extension Centers. Regional Extension Centers offer support to healthcare providers as they adopt electronic health records and move towards the American goal of having all healthcare treatment documented via electronic record methodologies.
The principal and founding goal of the first medical record librarians is still the foundation of HIM today—to increase and improve the clinical documentation standards. The method of documenting healthcare records has changed over the years from 100 percent hard-copied documents to the current hybrid of both paper and electronic records. The ultimate HIM goal of fully-functional electronic records with health information exchange in all treatment arenas including skilled, acute, home, and physician care; as well as ambulatory and emergency medicine has yet to be realized.